Rita M. Patel, MD Professor of Anesthesiology Vice-Chair, Education Associate Dean for GME & DIO University of Pittsburgh School of Medicine UPMC Medical

Rita M. Patel, MDProfessor of Anesthesiology

Vice-Chair, EducationAssociate Dean for GME & DIO

University of Pittsburgh School of MedicineUPMC Medical Education

Research in ResidencyMay 28, 2015

AAMC - 655 K Street, NW Washington, DC

Enhancing Research in Residency ProgramsUPMC Medical Education and Department of Anesthesiology

Tetsuro Sakai, MD, PhDProfessor of Anesthesiology and the Clinical &

Translational Science InstituteDirector of Scholarly Development

Director of Resident Research RotationUniversity of Pittsburgh School of Medicine

UPMC Med Ed Sponsored Programs # Programs # Trainees

ACGME ACCREDITED 118 1477

ACTIVE SIEP 35 73OSTEOPATHIC ACCREDITED 10 80

U PITT DENTAL 6 41U PITT PHARMACY 3 40

PODIATRY 1 17

TOTAL 173 1728

Hospitals: C-McK, Hamot, St Mgt, Mercy, SDY, Altoona A-Presby, MWH, WPIC & CHP

UPMC Med Ed Resident/Fellow Scholarly Activity Trainee as author or presenter

2013 Annual Report to the DIORita M. Patel, MD

UPMC Med Ed Resident/Fellow Scholarly Activity Trainee as author or presenter

Can “a scholarly program” facilitate resident scholarly activity?

Sakai, et al. Anesthesiology. 120:111–9;2014.


Increased UPMC Anesthesiology Residents’ Scholarly Productivity


Objectives

• Barriers for Residents & Faculty

• Systems for Residents & Faculty

• Outcomes

Sakai T, 10/6/2011

Reves, JG. Anesthesiology. 2007 Apr;106(4):826-35

SAKAI 5/27/2013

Sakai T, 10/6/2011


SAKAI 5/27/2013

Sakai T, 10/6/2011


SAKAI 5/27/2013


SAKAI 4/26/12SAKAI 5/27/2013

For Residents

• Awareness Introduction of researchers / projects

• Barrier breaker Research PBLD

• Non-clinical time Resident research rotation

• Assistance Director of Research Rotation

• Acknowledgement Web news

• Funding Department Seed Grant

NIH T32 Grant

Direction and Road Map forResidents

Blood Transfusion / Cell Saving / RBC Rheology

Jonathan Waters, MD

6

24

No Barrier (1)

Mild (2)

Moderate (3)Severe (4)

Complete Barrier (5)

0

50

Grants

No Barrier (1)

Mild (2)



0

50

100

Regulatory (IRB approval)

No Barrier (1)

Mild (2)



0

50

Statistics/data analysis

Three Biggest Barriers in Research

Sakai T, et al. Journal of Clinical Anesthesia. 25:434-8;2013.

Sakai T, 10/6/2011Sakai T, 10/6/2011

SAKAI 5/27/2013

Clinical Translational Science Institute

• Regulatory support• Pilot funding• Budget guidance/fiscal review• Industry sponsored research• eRecord research• Recruitment assistance• Statistical assistance

Resident Research Rotation

• ACGME-approved rotation

• 1- 6 months

• Director

Consultation

A letter of commitment by mentoring faculty

Weekly meeting

Milestones

Mandatory presentations

Abstract / manuscript submission

Abstract, Poster, Manuscript Review Committees

2002-2003

2003-2004

2004-2005

2005-2006

2006-2007

2007-2008

2008-2009

2009-2010

2010-2011

0

5

10

15

20

25

CA3 Resident Research Rotation

Non Rotators

Resident Research Rotators

Academic Year

Nu

mb

er

of

CA

3 R

es

ide

nts

Sakai, et al. SEA 2010SAKAI 5/27/2013

SAKAI 5/27/2013

T32 Training Grant (FY2008 – FY2017)

Yan Xu, PhD (PI)Professor, Vice Chair of Research

• Two years

• 80% guaranteed research time

• Faculty member upon completion

• NIH loan payment award

• Only 12 Anesthesiology programs


SAKAI 5/27/2013

A Comprehensive, Productivity-Based Faculty Compensation System

• FY 2004 - present

• Academic Track or Clinical Track

• Non-clinical time for Academic Faculty

• “Salary at risk” for non-clinical days

• Regain “salary at risk” via scholarly activities, which are converted to credit hours based on a Merit Matrix System

John P. Williams, MD

Sakai et al. British Journal of Anaesthesia. 111:636-50.2013.

Academic Project Mentor

75 credit hours/

resident project

Faculty mentorship is rewarded


After the new compensation system

was implemented, more original

peer-reviewed manuscripts by

academic faculty members were

published.



Increased UPMC Anesthesiology Residents’ Scholarly Productivity

Rank-to-Match Analysis• Study group = 38 UPMC anesthesiology residents

• Class 2009 - Class 2011

• Control group = 220 non-UPMC anesthesiology residents

• Those on the residency ranking list during the same academic

years who could have been matched with the program had they

ranked the program high enough on their list (rank-to-match).

• Comparisons

• % of residents with published peer-reviewed manuscripts

• quality of each publication assessed with Scholarly Activity Points

(SAPs)Sakai, et al. Anesthesiology. 120:111–9;2014.

Rank-to-Match Analysis

• Similar demographics (UPMC vs. Non-UPMC)

•Male gender

– 65.8% (25) vs. 64.5% (142), p = 0.89

•US medical graduates

– 89.5% (34) vs. 85.5% (188), p = 0.50

•Pre-residency publications

– 10.5% (4) vs. 13.2% (29), p = 0.088


Rank-to-Match Analysis

• Increased % of residents with publications in residency:

• 55.3% (21) vs. 13.2% (29), p < 0.0001

• Odds Ratio 8.14 (95% CI of 3.85 – 17.21)

• 0.7 per resident (28) vs. 0.2 per resident (42)

• Similar quality of publications and productivity per resident with publications

• SAPs per publication or SAPs per resident with publications without

any significant differenceSakai, et al. Anesthesiology. 120:111–9;2014.

Residents

Fellows

Medical Students

Junior Faculty Members

Chief Scholarly Officers

Junior Chief of Research

Direct of Scholarly Development

Director of Medical Students’ Research

Future Direction in the UPMC Department of Anesthesiology

Anesthesia Professorial Practice Rotation

CBY interns

SUMMARY

• Supporting research activity by residents is important for the future of our specialty.

• There are residents who wish to do research, but they face barriers in doing so.

• There are a number of strategies to improve resident scholarly productivity.

Acknowledgements

• Sandra C. Hirsch, MBA

• Patricia L. Karausky, RN, BSN, CCRC

• Shannon L. Valenti, MBA, CIP

• Susan L. Sandusky, BA

• Kathryn Riccio

• Mark E. Hudson, MD, MBA

• Peter J. Davis, MD

• Patrick J. Forte, MD

• Rita M. Patel, MD

• Yan Xu, PhD

• Trent D. Emerick, MD

• Nicholas J. Schott, MD

• David G. Metro, MD

• John P. Williams, MD

http://1.bp.blogspot.com/-tukXRHHQM0g/TbJoXCaUAVI/AAAAAAAAAhY/Tmnb1YVaTrE/s1600/Mount_Fuji_Japan%255B1%255D.jpg

2003 2004 2005 2006 2007 2008 2009 20100

10

20

30

40

50

60

70

11

Abstract Presentations by Residents

58

• Abstracts

• Peer-reviewed publications

• Book chapters

• Grants

• IRB / IACUC approvals

• Educational materials

Many Categories

•Abstracts – Regional, National, International

– Authorship

•Peer-reviewed publications – Original papers, Reviews, Case reports

– Journal Impact Factor

– Authorship

Variations in Quality & Contribution

• Each scholarly activity is converted to specially-assigned points based on a Merit Matrix.

• Modifiers:

• Degree of contribution

• Impact of the product

Scholarly Activity Points

Merit Matrix Points


http://1.bp.blogspot.com/-tukXRHHQM0g/TbJoXCaUAVI/AAAAAAAAAhY/Tmnb1YVaTrE/s1600/Mount_Fuji_Japan%255B1%255D.jpg

Clinical Translational Science Institute

• Regulatory support• Pilot funding• Budget guidance/fiscal review• Industry sponsored research• eRecord research• Recruitment assistance• Statistical assistance

“Pretreatment with Ondansetron Blunts Plasma

Vasopressin Increase Associated with

Morphine Administration in Ferrets”

Eric P. Wilkens, MD and Bill J. Yates, PhD

Anesth Analg 2005;101:1029-1033

Residents can publish!

Interns can be productive!

Mark Backeris, DO, MBA (Class of 2013)2nd Place, Western Pennsylvania Society of

Anesthesiologists (WPSA) (Original Research)

Trent Emerick, MD (Class of 2014) 2nd Place, WPSA (Original Research) Graduate Medical Education (GME), Association of University Anesthesiologists (AUA), Pennsylvania Anesthesiology Resident Research Conference (PARRC),Society for Education in Anesthesia (SEA)

Nicholas Schott, MD (Class of 2016)Anesthesia and Analgesia 117:1211-6;2013.

2002-2003

2003-2004

2004-2005

2005-2006

2006-2007

2007-2008

2008-2009

2009-2010

2010-2011

0

5

10

15

20

25

CA3 Resident Research Rotation

Non Rotators

Resident Research Rotators

Academic Year

Nu

mb

er

of

CA

3 R

es

ide

nts

Sakai, et al. SEA 2010SAKAI 5/27/2013

1 3 5 7 9 11 13 15 17 190

5

10

15

20

25

30

35

40

1 3 5 7 9 11 13 15 17 190

5

10

15

20

25

30

35

40

1 2 3 4 5 6 7 8 9 10111213141516171819200

5

10

15

20

25

30

35

40

TRADITIONAL No Adjustment UPMC System

Academic ClinicalAcademic

Clinical

($104)

(Faculty IDs)



Department of Anesthesiology Classes of 2003 – 2011

(n = 119)

• Scholarly activity points (SAPs) for all

scholarly activities were compared


Scholarly Activity Points

Objectives

• Importance of Resident Scholarly Activity



• Evaluation Methods

• Outcomes

• Potential Cost of Resident Scholarly Activityhttp://larsonfinancial.com/resident-fellow-financial-planning/

http://larsonfinancial.com/resident-fellow-financial-planning/



Objectives





• Outcomes

• Potential Cost of Resident Scholarly Activityhttp://larsonfinancial.com/resident-fellow-financial-planning/




For Residents


• Barrier breaker Research Problem-Based Learning

Discussion (PBLD)

• Time Resident Research Rotation



• Funding NIH T32 Grant

Department Seed Grant

For Residents



• Time Resident research rotation





For Residents



• Non-clinical time Resident research rotation




Department Seed GrantDavid G. Metro, MDResidency Program Director

For Residents








For Residents

• Awareness Introduction of Researchers / Projects







Objectives





• Outcomes

• Potential Cost of Resident Scholarly Activityhttp://www.musc.edu/intrad/

http://www.musc.edu/intrad/

Objectives





• Outcomes

• Potential Cost of Resident Scholarly Activityhttp://www.musc.edu/intrad/

http://www.musc.edu/intrad/

Documents

Rita M. Patel, MD Professor of Anesthesiology Vice-Chair, Education Associate Dean for GME & DIO University of Pittsburgh School of Medicine UPMC Medical